Durability of porcine and pericardial prostheses in tricuspid valve replacement

Brittany A Zwischenberger; Carmelo Milano; John Haney; Jeffrey G Gaca; Jacob Schroder; Keith Carr; Donald D Glower

doi:10.1016/j.xjon.2024.06.017

Durability of porcine and pericardial prostheses in tricuspid valve replacement

JTCVS Open. 2024 Jun 29:21:78-87. doi: 10.1016/j.xjon.2024.06.017. eCollection 2024 Oct.

Authors

Brittany A Zwischenberger¹, Carmelo Milano¹, John Haney², Jeffrey G Gaca¹, Jacob Schroder¹, Keith Carr¹, Donald D Glower¹

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, NC.
² Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla.

Abstract

Objective: Biologic valves dominate tricuspid valve replacement, yet data on different valve types are lacking. We compare the survival and durability of porcine and pericardial tricuspid prostheses.

Methods: A retrospective review of consecutive patients undergoing tricuspid valve replacement with porcine (N = 542) or pericardial (N = 144) prostheses between 1975 and 2022 was performed using a prospectively maintained institutional database. Concurrent procedures were included. Cox proportional hazards and logistic regression were performed.

Results: Patients who received the porcine prosthesis, compared with pericardial, were younger (56 ± 17 years vs 63 ± 15 years) and more likely to present urgently (55% porcine, 44% pericardial); however, there were no differences in redo status or concomitant operations. Ten-year survival was not significantly different between the porcine and pericardial groups (35% ± 3% vs 28% ± 4%, respectively, P = .2). The 10-year cumulative incidence of structural valve deterioration (porcine 9% ± 2%, pericardial 11% ± 3%, P = .8), reoperation for structural valve deterioration (porcine 5% ± 1%, pericardial 4% ± 2%, P = .06), and severe regurgitation (porcine 4% ± 1%, pericardial 5% ± 2%, P = .7) were not significantly different between groups. The failure mode was similar, with no difference in severe stenosis (porcine 32/47 [68%], pericardial 11/16 [69%], P = .9) or severe regurgitation (porcine 18/47 [38%], pericardial 7/16 [44%], P = .7). On regression analysis, valve type was not associated with survival (P = .6). Valve type was not associated with structural valve deterioration (P = .1) or reoperation for structural valve deterioration (P = .9).

Conclusions: In our series, there were no differences in survival or durability between porcine and pericardial valves. In most patients undergoing tricuspid valve replacement, the choice of porcine versus pericardial prosthesis is unlikely to affect clinical outcomes.

Keywords: pericardial bioprosthetic; porcine bioprosthetic; reoperation; structural valve deterioration; tricuspid regurgitation; tricuspid stenosis; tricuspid valve.